Elevated Liver Enzymes and Pain Meds

This message board is really my last hope so I pray to God someone responds to this post.
I have had chronic pain for about 10 years now. Mainly in both knees, left hip and lower back from arthritis, scoliosis, a slipped disk, and chronic bursitis. I've had 9 major knee surgeries in 10 years and have done everything known to mankind to manage my pain. I've been at the same pain clinic for about 3 1/2 years now. For the last two years I have been on 20 mgs of methadone TID and have tried multiple other drugs for breakthru (not really breakthru as the meth alone is not enough to get my pain reduced by 40% so I take the alloted BT's as prescribe on a daily bases - docs are aware buy will not increase my LA med). As of a few days ago I now take 4mgs of dilaudid QID in addition to the methadone. It seems to be the best combination thus far as my pain recently has been some what controlled (about a 4/5). So, in a nutshell, that's my history. Now for my lastest crisis.
About a month ago I was admitted to the hospital for an intense migraine which ultimately led me to dehydration (thus the admit). During routine blood work they discovered by ALT and AST (live enzymes) were highly elavated. My ATL was in the 700's (should be between 5 and 40). At the time, I was taking Norco, 10/325, QID. This was replaced with Dilaudid via PCP while in the hospital. My enzymes started to come down. An utltrasound was done and I was told the test showed fatty liver characteristics. Since the enzymes were coming down, it was left at this and I was discharged.
About 1 week after discharge, my ALT was down at 110. Two weeks later, last week, my ALT climbed to 125. Not a huge jump and nothing compared to the 700's I was at. My PCP called and said she knows how much pain I am in but because of the high enzymes, she wanted me to reduce my pain meds by 1/2 (I actually spoke to her rude nurse). She must have been convinced it was the pain meds causing the liver problems. Especailly since stopping the Norco and enzymes came down. I explained to the rude nurse, this was not possible as my pain was barely managed at the current dosage. Not to mention decreasing methadone by 1/2 could cause serious complications. She, the rude nurse, told me she would tell my doctor I "refused" her medical advise and hung up.
Since then, I have read just about everything and anything I can find about liver damage and opiods. With the exception of pain meds that contain tylenol, I can not find any supporting documentation that says opiods can cause liver damage.
I'm hoping someone on this board has been through a similiar experience and can offer some advise.
My next step of course, is to make another appointment with my PCP or perhaps even put a call into the pain clinic to get their advise. In the meantime, I am a wreck. If in fact my pain medicine is causing liver damage, then I have to make a choice to go back to a life of excruciating pain 24X7 or liver failure. What a choice. That's like asking someone to pick which child of theirs they would save if both were dying.
Oh! And one last tid-bit. I had my gall bladder removed about a year ago. At that time, my liver enzymes were also high however, dismissed because of the hot gall bladder. Not sure it matters but thought I'd throw that in.
If anyone has ever had elevated liver enzymes, I'd love to hear from you.

The Following User Says Thank You to kim3101 For This Useful Post:
Mackman (07-12-2012)

Hi,
Welcome to the pain boards. You are right, I would lay the blame squarely on the tylenol in the norco, and you can have that prescribed without any apap in it, but you would need to go to a compound pharmacist for it.
I am not sure why your doctor is saying this, do you think its possible she wants you off pain meds and is using this as an excuse? I have known doctors to do things like that.
If I were you, I would make an emergency appointment and see if she will write you a script for hydro without the apap, or possibly take you off oral meds altogether and put you on something like the patch.
If you dont drink alcohol, and dont have any underlying conditions such as hepatitus, Theres no reason to think it was anything other than the tylenol causing your problem.
Maybe Shoreline can help you too, he knows a lot more than I do about interactions and such. and like you said, others may have had this exact problem before.
Good luck to you and I hope you find the info you need.
Your Friend, Fabby

Thanks for the response, Fabby!
At first, I suspected the Norco but now, I don't think that's it.
The pain clinic took me off not because they thought it was the cause, but because they did not want me on anything that was too hard on the liver (the apap). I've been off Norco now for over a month and although my enzymes did initially come down, they are now trending back up and I haven't had any apap.
Let's say it was the apap that caused the issue to begin with. I've read it can take months for your liver enzymes to get back to normal but I can't find anything that says it will fluctuate up and down until it stablizes.
The real question here is can Methadone cause liver problems? This is the only medicine that has given me any quality of life and I'm scared to death I'll have to stop. I'm not runing in marathons or anything but I can at least take my dog for a walk around the block (even if I do have to rest afterwards!)
Just one more thing to worry about. Like we don't have enough, right?

As for my doctor - I've been with her for years and years. Although neither one of us is happy that I'm on these meds, I don't think she would try to scare me off. Maybe she was just CYA - you know? It could also be the way that nasty nurse interpreted her roders - who knows anymore!

I would ignore the nasty nurse and only listen to what the doctor says to you, Sometimes a snotty pa or nurse can put a spin on something the doctor never intended. I am stumped as to why your levels would go up then down then up again, I'll keep my fingers crossed for you that it is not the methadone, I certainly have never heard of methadone being particularly rough on the liver. Are you taking any iron suppliment, or minerals? do you have soft or hard water? maybe its some of the heavier metals that are causing this.
I hope you find the cause soon, I know what you mean, with all our problems, who needs more? I also have a dog, walking him is great exercize for me, and without him I wouldnt get out every day.

just how long and how much tylenol product have you been taking?the tylenol could have been the actual catalyst here and you do have some level of liver dysfunction from just that.pure opiates do not affect the liver or kidneys in any real huge way at all.i have kidney and liver disease from polycystic kidney disease.this disease also caused my then 12 year old son to actually develop liver failure then the need for a liver transplant.believe me, i watch what i take now.i am taking both oxycontin and oxy IR absolutely no more tylenol products at all for me anymore.you most definitely DO need to have at the very least a good thorough ultrasound or CT to really see whats up within your liver.there could be some connection as well between the GB thing and your liver functions.i really would get thee to a good GI doc for the best possible answers about what is really going on with your liver.there is NO reason to have to DC any pure opiates at this time.i do not know for certain about the methadone tho,i have never ever taken that,but lookup the Rxing info on the meth and see where it is actually metabolized in your body.some meds like tylenol are EXTENSIVELY metabed in the liver and some the kidneys.you need to obtain the best possible and ACCURATE info for your current situation and that realistically would be with a good GI doc.

you just really DO need to find the area that is responsible for the elevated enzymes and the alk phos raise.that 700 was very very high.DCing that norco was responsible for the lowering Im sure but the fact that things have not gotten completely back to normal really concerns me the most this would indicate some level of actual damage to alot of liver cells.while obtaining that US they can also make certain that all the areas of bloodflow,the biggest area being the portal vein,are all intact and flowing properly,they just do a doppler on the main artery and the portal vein to make certain the there IS indeed flow and the velocity is not being impedded in any way.this really just needs to be done in order to give yiou the full picture,labs alone do NOT tell the whole story when it comes to organ damage,trust me on that one.

you really just need to know the facts here so you can state them to your PM.when it comes to meds and some pain clinics,they actually will use just about any excuse to lower your meds or even deny a very badly needed raise.i was actually totally and completely lied to by a nurse practioner who was not my normal one when i very much needed a little raise in my OC for a severely damaged(needing surgery?hello)knee.this was the very first raise i ever actually asked for in well over four years of the very same dosage,it was just ridiculous to begin with.but my actual PM doc was really really ****** at the woman when i told him what she did to me and he had absolutely no problem in raising my OC up 20mgs.you just never know about certain people at your PM clinic.really.

just get the facts on what you are actually dealing with here before anyone starts taking away your life by removing pain meds from it.i wish you lots of luck with this and hope your damage is regenerated to at least some degree anyway.please keep us all posted.Marcia

FeelBad (cute name by the way).
What a coincidence....my mother and brother both have PKD. My mom just celebrated her 2nd "birthday" with her new kidney!
I was actually being tested as a live donor for her when they kept finding blood and protein in my urine. Went to a nephrologist and she DXd me with thinning of the kidney lining (can't remember the exact clinical name for it escapes me right now). She blamed that on chronic NSAID use and said no more for me - ever! Not even ibuprophen!
I too do not see the correlation between my meds and the liver problems. It has to be something else. Perhaps the fatty liver they seen in the US - I'm betting on that......
You sid the ALT score of 700 was very very very high - like how high? I know the rnage is between 5 and 40 but when its at 700 are we talking liver failure? You got me curious on this one...
As for how much tylenol - 1300 mgs a day (Norco 10/325 QID). Occasionally took 2 tylenol PM (1000 MG)extra strength when I was purely exhausted and in a lot of pain - I was desperate for sleep but still under the 4K max...I don't think it was the apa either but it is strange that it came down after DC.....

I have been on methadone for 4 yrs. now. My Dr.(pain specialist)put me on it cause it does not metabolize through the liver. Somehow it passes into the bloodstream differently than other pain meds. That's all I know. And I have read this many other times. boomer

I feel the same way...I am actually wondering if I should try an online pharmacy that doesn't need a referral. Has anyone had any luck with these? or is it all bogus. My rheumy freaks out because I am taking 2 37.5 ultracet a day, and then 2 tylenol 3's at night. Now he won't even give me any tylenols anymore...Don't know what to do. I still work, and try to carry on a normal life, but I do need these meds to do that.

Last edited by HBMod07; 06-04-2007 at 11:29 AM.
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